AB1446 TREATMENT PATTERNS IN A POLYARTICULAR JUVENILE IDIOPATHIC ARTHRITIS POPULATION IN GERMANY; A RETROSPECTIVE OBSERVATIONAL HEALTH CLAIMS DATA STUDY
Authors: G. Horneff, J. Borchert, J. Diesing, P. Klaus, R. Heinrich, H. Dally, C. Hagemann, S. Kock, T. Schoenfelder
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Treatment of polyarticular juvenile idiopathic arthritis (polyJIA) aims to ease symptoms and inflammation and reduce further damage and comorbidities[1]. Current treatment options however are not universally effective. With the first targeted synthetic disease modifying anti-rheumatic agent having recently been approved information on how many polyJIA patients may potentially benefit from newly accessible treatment options is needed. <h3>Objectives</h3> Describe current treatment patterns around incident polyJIA diagnosis and beyond, especially changes in medication regimes indicative of unsatisfactory response. <h3>Methods</h3> In a retrospective, observational analysis of two different non-overlapping longitudinal health claims databases (the WIG2, Scientific Institute for Health Economics and Health System Research GmbH, and InGef, Institute for Applied Health Research Berlin GmbH, databases), a representative sample in terms of age and gender of the statutory health insurance (SHI) population in Germany (about 3.5 and 4 million patients, respectively) was analysed. Two incident JIA cohorts were evaluated (2014 and 2015) in each databank, and followed up for 4 or 3 years, respectively. All incident JIA patients (without a JIA diagnosis during baseline, the 4 quarters prior to index) aged 2 to 15 years in the respective observation year (2014 and 2015), with continuous data throughout the observation year and minimum 3-year follow-up (or deceased) were included. Patients were considered to have polyJIA if they had at least one inpatient ICD-10 GM (German modification) diagnosis code, or two verified outpatient codes in two different quarters in the year, of M08.0 (juvenile chronic polyarthritis, adult type, includes rheumatoid factor (RF)+ polyJIA), or M08.3 (juvenile chronic arthritis (seronegative), polyarticular form, includes RF- polyJIA and extended oligoarthritis). We evaluated top-prescribed and pre-defined medications (by 4-digit ATC code) before, during, and following, incident polyJIA diagnosis. The pre-defined medication groups were non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids (GCs), conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs), and biologic disease modifying anti-rheumatic drugs (bDMARDs). <h3>Results</h3> Applying the inclusion and exclusion criteria to the incident JIA populations, we identified a total of 121 and 58 polyJIA patients in both 2014 and 2015, (of which 56 and 29 belonged to the 2015 cohort) in the InGef and WIG2 databases, respectively. Among the most frequently prescribed drugs were anti-inflammatory and anti-rheumatic drugs, specific anti-rheumatic agents, and nasal decongestants, immunosuppressive agents, vitamin B12 and folic acid. Prior to diagnosis, more than half of patients of the 2015 cohort were already receiving NSAIDs, however at diagnosis the use of csDMARDs increased more than bDMARD use. From diagnosis quarter to follow-up, there was a proportionally larger increase in the use of bDMARDs than csDMARDs, however use of all medications we examined (also NSAIDs and GCs) in our population continued to increase through follow-up (fig 1). Treatment patterns were similar for both cohorts (2014 and 2015). <h3>Conclusion</h3> Almost all patients continued to take NSAIDs during follow-up, many had concomitant medication with glucocorticoids in addition to csDMARDs or bDMARDs. This demonstrates there was an unmet need in the past for further advanced treatment options such as targeted synthetic DMARDs. <h3>Reference</h3> [1] Oommen, Prasad Thomas. 027-020l_S2k_Juvenile_Idiopathische_Arthritis_2020-10. Accessed December 17, 2021. https://www.awmf.org/uploads/tx_szleitlinien/027-020l_S2k_Juvenile_Idiopathische_Arthritis_2020-10.pdf <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Gerd Horneff Speakers bureau: Pfizer, Novartis, Sobi, Consultant of: MSD, Lilly, Grant/research support from: Novartis, MSD, Roche, Julia Borchert Consultant of: Julia Borchert is an employee of WIG2 GmbH, which is an independent institute and paid consultant to Pfizer Pharma GmbH for designing the study, carrying out the analyses, interpreting the results and writing the abstract., Grant/research support from: Julia Borchert is an employee of WIG2 GmbH, which is an independent institute and paid consultant to Pfizer Pharma GmbH for designing the study, carrying out the analyses, interpreting the results and writing the abstract., Joanna Diesing Consultant of: Joanna Diesing is an employee of WIG2 GmbH, which is an independent institute and paid consultant to Pfizer Pharma GmbH for designing the study, carrying out the analyses, interpreting the results and writing the abstract., Grant/research support from: Joanna Diesing is an employee of WIG2 GmbH, which is an independent institute and paid consultant to Pfizer Pharma GmbH for designing the study, carrying out the analyses, interpreting the results and writing the abstract., Pascal Klaus Employee of: Pascal Klaus in an employee of Pfizer Pharma GmbH., Ria Heinrich Consultant of: Ria Heinrich is an employee of WIG2 GmbH, which is an independent institute and paid consultant to Pfizer Pharma GmbH for designing the study, carrying out the analyses, interpreting the results and writing the abstract., Grant/research support from: Ria Heinrich is an employee of WIG2 GmbH, which is an independent institute and paid consultant to Pfizer Pharma GmbH for designing the study, carrying out the analyses, interpreting the results and writing the abstract., Heike Dally Employee of: Heike Dally in an employee of Pfizer Pharma GmbH., Christine Hagemann Employee of: Christine Hagemann in an employee of Pfizer Pharma GmbH., Simon Kock: None declared, Tonio Schoenfelder Consultant of: Tonio Schoenfelder is an employee of WIG2 GmbH, which is an independent institute and paid consultant to Pfizer Pharma GmbH for designing the study, carrying out the analyses, interpreting the results and writing the abstract., Grant/research support from: Tonio Schoenfelder is an employee of WIG2 GmbH, which is an independent institute and paid consultant to Pfizer Pharma GmbH for designing the study, carrying out the analyses, interpreting the results and writing the abstract.